Provider Demographics
NPI:1265759328
Name:AHMED, MASHRAFI (MD)
Entity type:Individual
Prefix:
First Name:MASHRAFI
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1273
Mailing Address - Country:US
Mailing Address - Phone:413-748-7076
Mailing Address - Fax:413-732-0225
Practice Address - Street 1:2 MEDICAL CENTER DR STE 410
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-732-0225
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055623207R00000X
TXP2411207R00000X
MA266166207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10558365Medicaid
TX300256001Medicaid
TX300256002Medicaid
ILXOH838266751OtherBLUE CROSS BLUE SHIELD
OK200433410 AMedicaid
TXTXB154132Medicare PIN